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2017 MEDICARE SUPPLEMENT COMPARISON GUIDE

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Glossary APPROVED

Glossary APPROVED CHARGES Also known as allowable charges, Medicare eligible expenses, or Medicare covered charges, applies to the specific dollar amount on which Medicare will base its payment for every conceivable medical procedure under Part B. Medicare will pay 80% of this “approved” amount. ASSIGNMENT This means doctors or suppliers receive payment directly from Medicare. When assignment is used, the provider of medical service agrees that his or her total charge for the covered service will be the charge approved by the Medicare carrier. Medicare then pays your doctor or supplier 80% of the approved charge, less any part of the $183 annual Part B deductible. Accepting assignment means that the doctor or medical provider will not bill you for the difference between the actual charge and the Medicare approved amount. Find out in advance whether your doctor or medical provider will accept assignment. When assignment is not accepted, you will be responsible for any amount up to 15% above the charges approved by Medicare. Using doctors or suppliers who accept assignment will save you money. Any physician may take assignment on a claim by claim basis whether he is a “participating” provider or not. CARRIER The Medicare Part B claims processor. For questions about your Medicare Part B claims payments, telephone 1-800-MEDICARE. CONTESTABLE CLAUSE A policy provision that gives an insurer the right to rescind your insurance policy in the event there are any errors, omissions or misstatements on your insurance application or enrollment form. The contestable period is generally the two years following the effective date of the policy. COORDINATION OF BENEFITS (COB) Means that one of your health insurance policies may reduce its benefits if you are also covered by another insurance plan. IMPORTANT! This usually applies only for employer-sponsored plans. Private Medicare supplements ordinarily do not have COB regardless of how many policies you have. COPAYMENT The amount that you or your insurance plan must pay to supplement Medicare’s payments for Part A and Part B expenses. For example, for charges incurred in 2017, you will have a $329 per day co-payment for days 61-90 and a $658 per day co-payment for days 91-150 while in a hospital. There is also a co-payment of $164.50 for skilled nursing days 21-100 and, for all Part B services, a co-payment of 20% after your annual Part B deductible of $183. DEDUCTIBLE The dollar amount that you will have to pay before either Medicare or your insurance plan will begin paying their benefits. Your Medicare Part A deductible is $1,316 per benefit period for 2017. Your Medicare Part B deductible is $183 of approved charges each calendar year. EFFECTIVE DATE The date your policy becomes effective. When you talk to your insurer, ask what the effective date will be. The effective date is printed on your insurance policy or certificate. EXCLUSIONS OR EXCEPTIONS The list of specific conditions or circumstances that are not covered by the policy. The exceptions in Medicare supplements are limited by state law and cannot exclude or limit coverage for any specific health condition for more than six months. Other health insurance plans such as hospital indemnities or medical surgical expense plans may have 12 month exclusion for preexisting conditions and/or permanent endorsements for certain health conditions. FREE LOOK The time period after you receive the policy in which you can review its benefits. State law requires Medicare supplement insurers to give the consumer 30 days to review the policy. If you return the policy within the 30-day free look period, you will get a full refund. Other types of individually marketed health insurance plans are limited to a 10-day free look period. GRACE PERIOD The time period, usually 31 days, for the payment of an overdue premium, during which time the policy remains in force. 10

GUARANTEED ISSUE RIGHTS (also called “Medigap Protections”) Rights you have in certain situations when insurance companies are required by law to sell or offer you a Medigap policy. In these situations, an insurance company can’t deny you a Medigap policy, or place conditions on a Medigap policy, such as exclusions for preexisting conditions, and can’t charge you more for a Medigap policy because of a past or present health problem. HOSPICE A program for the terminally ill. Medicare does reimburse most Hospice expenses if the Medicare patient chooses to take Hospice benefits instead of regular Part A and Part B benefits. There may be a co-payment for outpatient drugs and inpatient respite care. Care must be provided through certified Hospice organizations. INTERMEDIARY The Medicare Part A claims processor. For questions about Medicare Part A claims payments, call 1-800-MEDICARE. LIMITING CHARGE Effective January 1, 1991, physicians who do not accept assignment are limited as to what they can charge a Medicare beneficiary. In 2017, the limiting charge is no more than 15% over Medicare’s approved amount. Limiting charge information appears on Medicare’s Medicare Summary Notice (MSN) form. MATERIAL MISREPRESENTATION A misrepresentation that was important or essential to the decision to issue or not issue an insurance policy. MEDICAID A federal and state program that provides health insurance benefits for certain low income, disabled and blind individuals and families. There are strict income eligibility guidelines, and applications must be made at the local enrollment centers of the Department of Health & Hospitals. MEDICAL UNDERWRITING The process that an insurance company uses to decide, based on your medical history, whether or not to take your application for insurance, whether or not to add a waiting period for preexisting conditions (if your state law allows it), and how much to charge you for that insurance. MEDICARE CROSSOVER One of the more significant service enhancements that companies can offer. A “crossover” company has a contract with Medicare requiring Medicare to send the insured’s balance bills directly to the Medicare supplement insurance company. MEDICARE ADVANTAGE The new name for Medicare Health Plans (Part C). It is a section of the Budget Balancing Act (BBA) of 1997 that authorizes the Centers for Medicare & Medicaid Services (CMS) to enter into contracts with insurance companies, managed care organizations and other entities to give Medicare beneficiaries a choice in how they receive their Medicare benefits. MEDICARE HIGH DEDUCTIBLE PLAN A Medigap policy that will pay benefits as Plan F after one has paid a calendar year ($2,200) deductible. Benefits from high deductible plan F will not begin until out-of-pocket expenses exceed yearly high deductible ($2,200). Out-of-pocket expenses for this deductible are expenses that would ordinarily be paid by the policy. These expenses include the Medicare deductibles for Part A and Part B, but do not include the plan’s separate foreign travel emergency deductible. MEDICARE SELECT A type of Medigap policy that requires you to use hospitals within a specific network to be eligible for full benefits. 11

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